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News from the American Diabetes Association (ADA)
Update from Orlando, USA, 25–29 June 2010
ACCORD retinopathy study shows intensive glycae-
mic control, and combination dyslipidaemia therapy
with fenofibrate reduces retinopathy progression
A study group of the ACCORD study has shown that targeting
glycaemic control at the 6% HbA
1c
level and lipid therapy with
fenofibrate instead of placebo significantly reduced the rate of
progression of diabetic retinopathy.
1
Intensive blood pressure
control did not reduce progression.
The ACCORD study was an independent study sponsored
by the National Heart, Lung and Blood Institute and companies
did not participate in the study design or conduct, data accrual
or analysis, or manuscript preparation, providing only the study
drugs.
The more than 10 000 ACCORD patients with type 2 diabetes
and HbA
1c
higher than 7.5% were randomly assigned to either
the intensive glycaemic-control arm or standard control. Of
these participants, 5 518 with dyslipidaemia were also randomly
assigned in a two-by-two factorial design to receive simvastatin
and fenofibrate or placebo. The remaining 4 733 participants
were randomly assigned to either the intensive blood-pressure
control (
<
120 mmHg systolic blood pressure) or standard
therapy (
<
140 mmHg).
In this ACCORD eye study, participants with retinopathy at
baseline were excluded; those included were comprehensively
evaluated at baseline and at year four of the study. Progression
of diabetic retinopathy was defined as at least three steps on the
EDTRS severity scale, or development of retinopathy, requiring
photocoagulation therapy or vitrectomy.
Results of the progression to retinopathy and moderate vision
loss are summarised in Table 1.
The early stoppage of the intensive glycaemic-control arm
due to an increased rate of death from any cause after a mean
of 3.5 years has influenced the retinopathy results in this arm,
potentially underestimating the retinopathy benefits of good
glycaemic control.
The beneficial effect of fenofibrate therapy on the progres-
sion of diabetic retinopathy at four years (6.3 vs 10.2% on
placebo) provides further support to the findings of the FIELD
study, which also showed visual benefits with fenofibrate.
J Aalbers, Special Assignments Editor
1. The ACCORD study group and ACCORD Eye study group. Effects of
medical therapies on retinopathy p1.5rogression in type 2 diabetes.
N
Engl J Med
10.1056/NEJM oa1001288. Pub 29/6/2010.
Table 1. Progression to retinopathyand
moderatevision loss
Treatment
Progression of retinopathy Moderate vision loss
n
(%)
n
(%)
Glycaemic therapy
Intensive
104/1429
(7.3)
266/1629
(16.3)
Standard
149/1427
(10.4)
273/1634 (16.7)
Dyslipidaemia
With fenofibrate 52/806
(6.5)
145/908
(16)
With placebo
80/787
(10.2)
136/893 (15.2)
Antihypertensive
Intensive
67/647
(10.4)
145/749 (19.4)
Standard
54/616
(8.8)
113/ 13
(15.8)
